Towuaghantse v GMC & the importance of seeking early advice in inquest proceedings

In the recent case of Towuaghantse v GMC, Dr Towuaghantse sought to argue that the critical narrative conclusion of a Coroner could not be adduced in evidence against him before his regulator. That the findings of fact made by the Coroner could be adduced was not in dispute.

The facts of the case are tragic but not critical to the assessment of the law and the potential impact upon healthcare professionals who find themselves facing an inquest and so I will not set them out here.

In short, Dr Towuaghantse was criticised by the Coroner in a narrative conclusion following the inquest touching upon the death of Patient A. This narrative was submitted as evidence by the GMC and relied upon by the Medical Practitioners Tribunal (MPT) in its determination that the doctor’s fitness to practise was impaired and that he had shown limited insight and remediation. The MPT went on the conclude that, given the doctor did not accept the criticisms made by the Coroner or the Tribunal’s own findings, he had limited ability to fully remediate the concerns raised and as such an order for his erasure was the only reasonable sanction to ensure protection of patients and public confidence in the profession.

The court found that the narrative conclusion of the Coroner could safely be admitted in proceedings before the MPTS. While the rule on the inadmissibility of evidence heard in another forum, or the findings of another court, has long been established in civil or criminal proceedings, this rule does not apply to inquisitorial proceedings such as those before a regulatory body.

Mr Justice Mostyn quoted the General Medical Council (Fitness to Practise) Rules Order of Council 2004 (SI 2004 No. 2608), r.34(1) which states that:

The Committee or a Tribunal may admit any evidence they consider fair and relevant to the case before them, whether or not such evidence would be admissible in a court of law.”

However, he went on to say that, while the narrative conclusion of the Coroner was admissible, the Tribunal had to ensure that it was not used against Dr Towuaghantse unfairly and should be weighed with all other evidence in determining the facts. The Tribunal rightly held that it was not bound by the Coroner’s findings but erred in relying upon the doctor’s failure to accept the Coroner’s findings when considering impairment of his fitness to practise.

In fact, the Tribunal used Dr Towuaghantse’s defence of his conduct before the Coroner, refusal to accept the Coroner’s criticisms and defence of the facts before them as evidence of a lack of insight and his inability to remediate. This was found to be procedurally unfair; a practitioner is entitled to defend his or her position and exercising this right should not be construed as a refusal to remediate, or as evidence of incapacity to do so, unless the Tribunal has made findings of blatant dishonesty.

That said, this case shows the importance for healthcare professionals to obtain early advice and representation when they are called to give evidence before HM Coroner as findings of fact or a critical narrative can be admitted as evidence on the facts in regulatory proceedings.

Laura Bridge, Associate, BLM

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